Case contributed by Dr Mohammad A. ElBeialy


22 year old gentleman with chronic headache and dizziness.

Patient Data

Age: 22 years.
Gender: Male
  • the pineal region shows a lobulated soft tissue mass lesion, it measures about 2.9 X 2.7 X 2.7 cm in its main diameters. 
  • the lesion shows mildly hypointense T1 and hyperintense T2 / FLAIR signal, with inhomogenous post-contrast enhancement. 
  • the lesion shows mild restricted diffusion. 
  • a suspected small signal void focus is seen at its peripheral anterior aspect of the lesion (which was evident on CT study that was available with the patient). 
  • the lesion is seen compressing the superior portion of the cerebral aqueduct with moderate supratentorial hydrocephalus as well as transependymal CSF permeation. 
  • mild downward herniation of the cerebellar tonsils is noted.

MR spectroscopy of the lesion shows:

  • elevation of the choline and lipid lactate peaks.
  • depression of the neural markers; N-acetyl aspartate (NAA) and creatine (Cr).
  • prominent glutamate and taurine peaks at 3.4 ppm with shot TE signal voxel MR spectroscopy.

Case Discussion

Pineal body malignant mass lesion; pineoblastoma with moderate supratentorial hydrocephalus. The differential diagnosis is a germinoma which gives typical MRI appearance, yet with the calcification is typically central in germinoma and peripheral in pineoblastoma.

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Case information

rID: 23722
Published: 4th Jul 2013
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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